Medical and scientific investigations concerning speech defects have been as considerable as it is contradictory. The observations of prominent doctors and specialists, some of them being afflicted themselves, have in the most argumentative thesis attributed stammering-stuttering to numerous and varied causes, the enumeration of which has a real historical and pathological interest:
Faulty action of the tongue, disorders of tongue-muscles, spasms of the glottis and epiglottis, troubles located in the larynx and in the hyoid-bone, abnormal depth of the palate, affections of the muscles of the lower jaw, spasm of the lips, abnormal dryness or moisture, or lesion of brain, nerves, muscles or tongue, nervous affection, intermittent necrosis, general debility or weakness, chorea, incomplete cerebral action, imperfect will-power, want of harmony between thought and speech, imitation and habit.—Such is the nomenclature of the principal ingenious theories exposed and upheld by those who have made a study or a business of the cure of speech defects. But some mistaken innovators, not satisfied with theories and investigations, gave to their ideas an experimental form. Forty and forty-five years ago a surgical craze, originating in Germany as a pretended cure of speech defects, was raging all over Europe. Stammerers and stutterers suffered a variety of operations, the horizontal section of the tongue, the division of the lingual muscles, the division of the genio-hyo-glossi muscles, the cutting of the tonsils and uvula, etc. Such suppression and mutilation of the vocal organs could not bring any cure, as it was proved, and some patients having died, the operating craze was put to an end forever. Since that it is by more gentle means that all attempts have been made to cure impediments of speech. The unfortunate stutterer has no longer to dread the misemployed zeal of surgical operators, and now it is even his own fault when he allows himself to fall into the hands of ignorant charlatans.
Without lessening the value of former discoveries, I will say that the specialist of to-day must disagree with the most eminent authors and the most prominent works on that question, including Velpeau, Amussat, Becquerel, Lenbuscher, Bèclard, Bristowe, etc., and arrive at the conclusion that their testimony was one-sided, being confined to their own or few cases, and limited to mere theory and speculation. For the treatment of vices of speech, with the indispensable knowledge, long and practical experience alone will instruct what is the right method to pursue. The various theories on the nature and causes of that infirmity, and the enumeration of the different responsible organs may be, at the same time, partly false and partially true; but they have proved powerless to cure or relieve.
In all varieties and forms of stammering-stuttering all the vocal organs can be blamed, and have, in each case, to be reformed and improved. In the majority of cases we find some traces of the organic peculiarities aimed at by authors, even if their influence is doubtful. Respiratory trouble is at the bottom of every case. The internal organs, and the tongue, the lips and jaws are to some extent in an abnormal condition, and suffer a convulsive spasm; they have to be treated, strengthened and made flexible. The nerve-function of the organs of speech is also disturbed. We notice in the majority of cases, to a certain degree, organic weakness, nervousness, lack of will-power, and above all, disregard of all natural rules and ignorance of the use and natural functions of the organs of speech.
As to prognosis, I will say that all stoppages in speech, accompanied by spasms, sometimes hardly perceptible, and which are not the result of paralysis or lesion, may be classified as stammering-stuttering, and can always be cured, whatever may be their origin or cause, or their intensity, and that it is only a question of time and perseverance even for the most stubborn cases.
The treatment of stammering-stuttering, which does not comport any operation nor drugs, is purely educational. It consists in remedying the defect and teaching properly the science of speech. Still, I think, that in many cases a strict attention ought to be paid to hygienic measures; some medical care and prescription would help the patient and the instructor. In the actual condition of things no regular practicing physician can afford to devote his ability and time to the treatment of speech defects. But doctors have to study the infirmity, to know that it can be cured, that it is an interesting and complex disease, in the treatment of which the progress of medical science can bring a revolution. Physicians the world over having wholly neglected to consider that question, the result has been to leave it in the hands of incompetent persons. In principle the question of speech impediments cannot be separated from medicine. Physicians cannot ignore an infirmity in which the organism itself is undoubtedly involved, at times in a very intricate manner and to a considerable extent. Every true physician feels that he has a sacred mission—to alleviate suffering; the tortures of a large class of people partially deprived of the faculty of speech are well worth his care and attention. Medical students ought to be provided with the means of becoming versed in an affection offering such a large field for study and work, where so much light is needed, and where the prospects of discovery and improvement from a scientific and medical standpoint are so legitimate. The family physician, often consulted, will do good work in advising his clients to try and get rid of such a terrible affliction, to be cured without delay, and in preventing them from falling into the hands of quacks.
HOMELY FACTS.
BY F. STEWART, CLEVELAND, O.
Not long ago as a bottle was placed upon the counter of a pharmacist to be refilled, its inner walls were observed to be richly decorated with the active principles of the compound. A witch-hazel doctor standing by declared the decorated walls to be the secret of the patient's recovery, but upon inquiry it was found that the patient was no better. Still they had decided to try another bottle, and the apothecary was not the one to object. The investigation was carried no farther, but if it had been the same old story of incompatibles would have been retold. To the aqueous solutions containing oleoresinous tinctures or extracts (such as cannabis indica, guaiac, benzoin, lupulin, ginger, myrrh, cubeb, eucalyptus, sumbul, and many others) a sufficient quantity of carbonate or calcined magnesia should be added. A few grains (say three to twenty) to the prescribed dose will suffice for a good suspension, and will be found in most cases unobjectionable of course in an acid mixture.
There are many conflicting reports of this class of medicines, owing to unscientific prescribing as well as unreliable preparations. The activity of this class of medicines demands nothing short of strong alcohol for their extraction. Yet many weak and worthless preparations may be found in the market. If the unscientific observers would look more to the quality of their goods, these conflicting reports would begin to subside.